Shun Thomas Au Tak, Wai Wong Tai, Chiu Lau Chor
Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, PR China.
Eur J Emerg Med. 2006 Apr;13(2):72-5. doi: 10.1097/01.mej.0000192046.19977.5a.
The management of acute temporomandibular joint dislocation relies on the traditional method, which involves intraoral manipulation of the mandible on both sides of the patient. Often, intravenous sedative or analgesic agents are needed to facilitate closed reduction. In this report, the authors introduce a new approach called the ipsilateral approach, in which extraoral or intraoral manipulation of the dislocated side is performed to accomplish closed reduction, without using sedatives or analgesics. Three methods, namely, extraoral, intraoral and combined, are described.
A prospective observational study was performed to investigate this ipsilateral approach. Six medical officers were recruited to attend to patients with acute temporomandibular joint dislocation. The following protocol was used: (1) Try the extraoral method in all patients first. (2) If it fails, use the intraoral method. (3) If both fail, attempt using a combined method. (4) If all fail, perform the traditional method as usual.
A total of 24 episodes of temporomandibular joint dislocation were examined, out of which 13 were successfully reduced by the extraoral method. Of the remaining 11 episodes, 10 were successfully reduced by the intraoral method, the last case being reduced by the combined method. None of them requires sedation or analgesia.
This ipsilateral approach, using extraoral and intraoral methods, is cost-effective, simple and convenient for the management of acute temporomandibular joint dislocation.
急性颞下颌关节脱位的治疗依赖传统方法，即对患者双侧下颌骨进行口内操作。通常，需要静脉注射镇静剂或镇痛药以促进闭合复位。在本报告中，作者介绍了一种名为同侧法的新方法，即对脱位侧进行口外或口内操作以完成闭合复位，无需使用镇静剂或镇痛药。文中描述了三种方法，即口外法、口内法和联合法。
进行一项前瞻性观察研究以调查这种同侧法。招募了六名医务人员来诊治急性颞下颌关节脱位患者。采用以下方案：（1）首先对所有患者尝试口外法。（2）如果失败，使用口内法。（3）如果两者都失败，尝试使用联合法。（4）如果全部失败，则按常规进行传统方法。
共检查了24例颞下颌关节脱位病例，其中13例通过口外法成功复位。其余11例中，10例通过口内法成功复位，最后1例通过联合法复位。所有病例均无需镇静或镇痛。
这种使用口外法和口内法的同侧法，对于急性颞下颌关节脱位的治疗具有成本效益、简单且方便。
